This article gives an insight into some possible intervention strategies using the basic principles of hypnotherapy. An excerpt of a treatment is described, showing the main effect with this individual person. The therapist applied the idea of unconscious seedings by narrating other clients' strategies. At the end, he supports the search of individual strategies. Abstinence was controlled one year after the last meeting by self-report and CO-measurement.

While health warnings are present on cigarette packs around the world, the nature of the warnings varies considerably between countries. In the United States, a small text warning citing the dangers of cigarette smoking is found on the side of all packs. This pilot study sought to determine whether graphic cigarette warning images, like those found in the United Kingdom and Canada, were better at decreasing cravings to smoke than existing text warnings found on cigarette packs in the United States. Twenty-five smokers seeking treatment to quit at a specialty tobacco treatment program were administered the Brief Questionnaire of Smoking Urges (QSU — BRIEF), a validated measure of craving, prior to and following exposure to cigarette pack warning images. The graphic cigarette warning images reduced cravings to smoke (6.20 point decrease) more than neutral images (3.36 point decrease) and current text warnings used in the United States (5.75 point decrease), although this difference was not statistically significant. Based on these pilot data, a larger study could further examine the effectiveness of graphic warning images and whether such warnings hold an advantage over the currently used text warnings.

The purpose of this study was to develop a theoretical explanation of the process of becoming a father and how this impacted on smoking behaviours of men during their partner's pregnancy. Grounded theory method and constant comparative analysis was used to explain data from interviews with 23 men from rural Midwest USA. Becoming a father prompted participants to seek ways to protect their partners and babies from the effects of cigarette smoking. First-time fathers were particularly receptive to quitting smoking early in their partner's pregnancy, whereas motivation to quit declined as pregnancy progressed for first-time fathers and other fathers. Although protecting their families from cigarette smoke remained constant, men's smoking goals and behaviours became increasingly focused on minimising harm rather than quitting as their partner's pregnancy progressed. Findings support the view that the transition to fatherhood is an opportune time in which to encourage and support smoking behaviour change for male partners. Theoretical insights provide understanding of why and when expectant fathers attempt to quit smoking and reduce harm to their families. Future research should focus on appropriate and timely interventions to maximise the success of men to quit smoking when they are naturally motivated to do so.

Smoking is widely known as an architect of well-documented, negative health outcomes. The advent of legislated actions to ban work- and public-place smoking has reduced the overall smoking prevalence in Canada and around the world. However, what is often overlooked are patients with psychiatric illness who are confined in psychiatric institutions and are not able to take advantage of designated smoking areas. The aim of this commentary is to raise awareness of potential inequitable conditions that are inherent in workplace smoking restrictions particularly for psychiatric patients. A biological and social equity perspective will frame the discourse of the issue.

Homework assignments have been a key component of cognitive behavioural therapy (CBT) for decades, but very few studies examined the effect of compliance on outcome in regard to smoking behaviour. To fill this gap in the existing literature, the present report evaluated the role of homework compliance on short-term outcome in the context of evidence-based care for smoking cessation. Compliance with out-of-session assignments was assessed in a four-session CBT-nicotine replacement therapy protocol for smoking cessation among adult daily smokers (n= 94). Consistent with expectation, homework compliance was associated with better short-term outcomes, including amount of cigarettes consumed as well as abstinence. Importantly, these effects remained after controlling for a wide range of potentially confounding variables (e.g., motivation to quit, nicotine dependence at intake, attendance problems, and in-session participation). Estimates of quantity versus quality of homework compliance did not differentially predict outcomes. Out-of-session homework assignments incrementally predict short-term smoking abstinence in the context of evidence-based care for smoking cessation.

Introduction:The aim of the current study was to assess the impact of an intervention aimed at communicating the negative reinforcement explanation for smoking, a set of ideas derived from popular self-help books, upon participants' cognitions and urges to smoke. Methods: Smokers (n = 205) undergoing standard stop-smoking treatment were randomised to receive either the experimental intervention, a brief intervention aimed at communicating the explanation or a control intervention, a video on the health risks of smoking. Outcomes were participants' acceptance of the negative reinforcement explanation for smoking, positive outcome expectations for smoking, self-efficacy and urges to smoke reported at one week post-cessation. Results: Post-cessation urges to smoke were similar in the two groups (Adjusted expt. group mean = 2.50, Control group mean = 2.75, F(1,60) = 0.98, p = .33). Other cognitive measures were also unchanged. Conclusions: The brief cognitive intervention offered as an adjunct to standard care failed to reduce urges to smoke or alter smokers' cognitions. Changing smokers' cognitions may be as challenging as changing their behaviours. Suggestions are provided for further research.

Introduction:Proschaska's transtheoretical model (TTM) of behaviour change suggests that a population of smokers varies along many dimensions, including readiness to quit and the presence of other risk factors. This study examines whether smokers contemplating quitting are more likely to be contemplating another change (e.g., Pap testing and physical activity). Methods:The study used self-reported cross-sectional data (n= 2,873) from the Canadian Community Health Survey (CCHS) Cycle 4.1 2007/2008. The association between the smoking stage of change (SOC) and Pap testing behaviour was assessed. Control variables included sociodemographic and behavioural characteristics (e.g. doctor visits and number of cigarettes smoked). The distribution of health behaviours (e.g., dietary changes and exercise) by smoking SOC among women with recent Pap tests was also examined. Results:Female smokers contemplating or preparing to quit smoking had higher odds of having a recent Pap test, OR = 1.40, 95% CI (1.19, 1.65), and OR = 1.82, 95% CI (1.47, 2.25) respectively, compared to smokers who had no intention of quitting. This association remained statistically significant after adjusting for confounders, AOR = 1.28, 95% CI (1.08, 1.52), and AOR = 1.63, 95% CI (1.31, 2.04) respectively. Fruit and vegetable consumption, physical activity, and recent dental visit were associated with advanced smoking SOC among women with recent Pap tests (P< .05). Conclusions:Advanced smoking SOC was associated with the increased likelihood of having a recent Pap test and engaging in other healthy behaviours. These findings show that targeting several health behaviours simultaneously may be an effective health promotion strategy.

Despite substantial efforts to decrease its prevalence, it is estimated that more than 20% of French women continue to smoke during pregnancy. The aim of this study was to assess the perceived stress and coping strategies used by pregnant smokers when they seek help to stop smoking. Eighty pregnant women were involved. Pregnant women who stated their intention to quit smoking (n= 40) were compared with pregnant nonsmokers (n= 40). All participants filled out the Brief Cope (BC), the Perceived Stress Scale (PSS) and the Hospital Anxiety Depression Scale (HADS). In addition to these self-report scales, pregnant smokers completed the Fagerström Tolerance Questionnaire (FTQ). The results show that pregnant women who smoked used less active coping, planning, and positive framing, considered a good adaptive strength, and had significantly elevated scores on perceived stress and anxiety scales than nonsmokers. This research is the first to provide Brief Cope results for pregnant smokers seeking help to stop smoking linked to perceived stress. The results obtained contribute to the well-known psychosocial factors in maintaining smoking during pregnancy and will be used in the implementation of more effective intervention programs among pregnant women.

Overview:Many U.S. hospitals use fax-referral to quitlines to provide outpatient follow-up. It is important to understand whether it is better to refer all smokers, or only those ready to quit, to quitline services. The purpose of this pilot project was to evaluate the feasibility and intermediate out-comes of a proactive (offering fax referral to all smokers) versus a reactive (pre-screening for readiness to quit within the next 30 days) approach to quitline fax-referral. Method:We employed a pre-test, post-test comparison group design in which a script-based reactive approach was employed over a two-week period and a script-based proactive approach was employed in the following two-week period. Scripts were inserted into the counselling protocols of a pre-existing inpatient treatment program. Major Findings:We enrolled 45 patients — 25 during the reactive, and 20 during the proactive block. In the reactive group, 12 (48%) indicated that they were ready to quit smoking and accepted fax-referral to the quitline. Nine (75%) were successfully contacted and enrolled in the quitline, for an overall quitline enrolment rate of 36% (9/25). In the proactive group, all accepted fax-referral to the quitline and 11 were successfully contacted and enrolled by the quitline for an overall enrolment rate of 55% (11/20). Quitlines were able to reach and enrol a higher proportion of patients referred to them, when patients were pre-screened for readiness to quit. Offering quitline referral, regardless of readiness to quit, potentially expands the reach and possibly the impact of quitline counselling.

Background and Objectives:Tobacco smoke contains many substances that are harmful and induce cancerogenesis. Carbon monoxide (CO) is the parameter commonly monitored by smoking cessation centres. The purpose of this study was to analyse other parameters and risk factors, including respiratory function and CEA (serum carcinoembryonic antigen) levels, in patients undergoing smoking cessation. Methods:One hundred and eighty current smoking patients current smokers were recruited from the outpatients for smoking cessation. Sociodemographic and lifestyle analyses were performed on them. They were also studied for respiratory function parameters and CEA (serum carcinoembryonic antigen) levels. A control group of 171 former smoking patients were also studied for functional and clinical parameters. Current smokers were also monitored for several parameters in the first 3 months after starting therapy with nicotine inhaler and varenicline, in addition to the behaviour therapy. Results:Some functional and clinical differences were found between the smokers and the former smokers groups. In the smokers' group we found no significant differences in sociodemographic and lifestyle between females and males. Regarding the response to varenicline-nicotine treatment combined with minimal advice, 56% of patients stopped smoking after 3 months of therapy; 30% of these had a level of severe bronchial obstruction. Operating parameters and the level of CEA at the beginning of the therapy were evaluated after 3 months, showing significant differences. Carboxyhemoglobin was reduced by 1.06%, oxyhemoglobin increased by 2.94%, FEF 25/75% increased by 16%. Conclusions:We can say that smoking cessation leads quickly to the improvement of clinical, functional and laboratory parameters. Patients with severe obstruction are more motivated to stop smoking.

An important element of smoking cessation programs is the modification of health beliefs about risks and benefits. However, Janis and Mann's (1977) conflict-theory suggests only vigilant decision-makers are motivated by such outcome appraisals. Thus, this study examined the extent to which relations between health beliefs and cigarette smoking are moderated by decision-making competence. Over 150 university undergraduates completed a questionnaire survey assessing health beliefs about smoking (perceptions of susceptibility to and severity of lung cancer, and benefits of not smoking), smoking intentions, and decision-making competence. Hierarchical regression analysis revealed interactions between risk perceptions and competence, whereby perceived susceptibility and severity appraisals better predicted smoking intentions in less proficient decision-makers. However, these interactions disappeared after controlling for smoking status. These findings suggest that risk perceptions are more important in college students averse to information search and appraisal, albeit this is confounded by smoking status.

Introduction:The aim of this study was to assess Veterans' and primary care clinic staff's knowledge about, and experiences with, tobacco cessation services available through their Department of Veterans Affairs (VA) medical facility. Methods:Qualitative, semi-structured, in-depth interviews and surveys were conducted with 7 patients and 12 providers/clinic staff members at three VA primary care clinics serving large numbers of rural Veterans. Interviews were transcribed and coded for the- matic content. Results:Five primary themes emerged: (1) lack of knowledge about available cessation services, (2) smoking cessation services provided to patients, (3) perceived barriers to cessation and the provision of treatment, (4) patient receptiveness to treatment and primary care provider involvement, (5) recommended strategies for improving smoking cessation services. Discussion:Our findings suggest there is a considerable lack of knowledge regarding available tobacco cessation services in VA primary care clinics serving rural Veterans. While many patients expressed the opinion that VA was providing adequate care for nicotine dependence, they also identified important barriers to cessation and offered opinions regarding what more could be done to help them to quit smoking. Clinicians/staff also provided insight into barriers they encounter in the delivery of cessation services. Future work should focus on attempting to address these barriers.